Hajikarimloo Bardia, Tos Salem M, Habibi Mohammad A, Mohammadzadeh Ibrahim
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA -
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
J Neurosurg Sci. 2025 Aug;69(4):341-349. doi: 10.23736/S0390-5616.25.06514-2.
Managing foramen magnum meningiomas (FMMs) poses challenges due to their anatomical complexity. Surgical resection aimed at achieving gross total resection (GTR) is the primary therapeutic option; however, the proximity to nerves and arteries complicates resection and is associated with significant morbidity and mortality rates, reported to reach as high as 50% and 25%, respectively. Stereotactic radiosurgery (SRS) is a non-invasive radiotherapeutic modality that has been extensively used to treat intracranial meningiomas and is associated with high rates of favorable outcomes and low complications. This study aimed to evaluate the efficacy and safety of SRS for FMMs.
We searched the electronic databases from inception to October 24th, 2024. We included studies that evaluated the radiological and clinical outcomes of SRS application in FMMs. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. The R program was used to perform the meta-analyses, sensitivity analysis, and publication bias.
Our study included five studies with a total of 174 patients. Our meta-analysis revealed that SRS resulted in a pooled local control (LC) rate of 99% (95% CI: 96-100%), an objective response (OR) rate of 49% (95% CI: 25-74%), a stable disease (SD) rate of 48% (95% CI: 25-71%), and a progressive disease (PD) rate of 1% (95% CI: 0-4%). Our results indicated a pooled clinical improvement rate of 43% (95% CI: 11-80%) and a clinical stability rate of 56% (95% CI: 21-87%). The meta-analysis showed that SRS had low heterogeneity (I=0%, P=0.84) and a pooled adverse radiation effect rate (ARE) of 0% (95% CI: 0-1%).
SRS is associated with promising clinical and radiological outcomes and low complication rates. It can be considered for use in asymptomatic or minimally symptomatic individuals with small- to medium-sized lesions, symptomatic individuals with significant comorbidities without brainstem compression, and those who are reluctant to undergo surgery.
枕骨大孔脑膜瘤（FMMs）因其解剖结构复杂，治疗颇具挑战。旨在实现大体全切（GTR）的手术切除是主要治疗选择；然而，其与神经和动脉毗邻，使切除复杂化，且与较高的发病率和死亡率相关，据报道分别高达50%和25%。立体定向放射外科（SRS）是一种非侵入性放射治疗方式，已广泛用于治疗颅内脑膜瘤，且疗效良好率高、并发症低。本研究旨在评估SRS治疗FMMs的疗效和安全性。
我们检索了从数据库建立至2024年10月24日的电子数据库。我们纳入了评估SRS应用于FMMs的放射学和临床结果的研究。使用干预性非随机研究的偏倚风险工具评估偏倚风险。使用R程序进行荟萃分析、敏感性分析和发表偏倚分析。
我们的研究纳入了5项研究，共174例患者。我们的荟萃分析显示，SRS的汇总局部控制（LC）率为99%（95%CI：96 - 100%），客观缓解（OR）率为49%（95%CI：25 - 74%），疾病稳定（SD）率为48%（95%CI：25 - 71%），疾病进展（PD）率为1%（95%CI：0 - 4%）。我们的结果表明汇总临床改善率为43%（95%CI：11 - 80%），临床稳定率为56%（95%CI：21 - 87%）。荟萃分析表明SRS异质性低（I² = 0%，P = 0.84），汇总不良放射效应率（ARE）为0%（95%CI：0 - 1%）。
SRS具有良好的临床和放射学结果且并发症发生率低。对于无症状或症状轻微的中小尺寸病变患者、有严重合并症且无脑干受压的有症状患者以及不愿接受手术的患者，可考虑使用SRS。
